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Marcos Segovia is a proud Mexican immigrant. He refuses to accept any welfare assistance. As a result of that choice and his low income, he and Dora, his wife, have no health insurance for themselves or for their children . This is one of Dora’s major concerns. Speaking of how she worries whenever one of her children gets sick, Dora said, I just wait and pray for them to get better. Sometimes, I’ll purchase overthe -counter drugs or use home remedies. If things don’t get better, we take them to a doctor or a pharmacy in Mexico. At times even going to the doctor over there is expensive, but it’s much less expensive than the cost of health care here in the Valley. I prefer to take my children to Mexico because I am more confident they will get better. Lack of access to quality health care is a daily part of life for many residents of the South Texas border. This is especially true for those who live near or below the poverty line. Most would prefer to use conventional medical practices and practitioners but simply cannot afford to do so. Like Dora, they may turn to informal channels or just wait (and pray) that the illness will go away. For many, informal channels of health care are their only option. Such informal channels include going to Mexico to see health professionals or to buy prescription drugs (often without a prescription); using the prescription medications of a friend or family member; not claiming all their income so that their children, at least, can have Medicaid coverage; and using folk healing practices and/ or practitioners. To the degree that formal systems fail to meet the needs of a large segment of the population, no one should be surprised when they turn CHAPTER 7 The Informal Health Care Economy With Dejun Su Richardson-final.indb 197 Richardson-final.indb 197 8/7/12 10:30:34 PM 8/7/12 10:30:34 PM 198 The Informal Health Care Economy to informal means. This failure is particularly acute in Texas in general , and along the border, in particular. Texas, according to a 2005 U.S. Census report,1 had the largest percentage (24.4%) of people without health insurance coverage of any state. The border states of New Mexico and Arizona were not far behind, with 21.9% and 19.6%, respectively . Even California, the remaining U.S.-Mexico border state, had a rate of 18.6%, just behind Mississippi, at 18.8%. By comparison, the U.S. average is 15.4% uninsured. Not only are these border states at or near the top in the percentage of their citizens without health insurance, but the uninsured rates of one particular group—border Hispanics—have been especially high. In Texas, 38.5% of Latinos did not have health insurance in 2005, compared to 13.9% of Anglos and 26.2% of blacks/others. And within this group, those age sixty-five or less who are not covered by Medicare/ Medicaid fare even worse. In one study of Texas border counties using a random sample, Bastida and other researchers2 found that 65% of Latino respondents under sixty-five years of age reported having no health insurance. Along with having an extremely high rate of uninsured people, Hidalgo County is also among the three or four counties in the U.S. with the lowest average household income. Yet ironically, the costs of health care here are among the highest in the U.S. as measured by average Medicare costs per person. According to a recent article in the New Yorker3 magazine, Medicare spent an average of $15,000 per enrollee in Hidalgo county—or almost twice the national average—while the average income per capita was only $12,000. As the article states, “Medicare spends three thousand dollars more per person here than the average person earns.”4 One of the factors contributing to the high cost of health care in the area, according to Gawande, is that many prescribed treatment procedures are unnecessary, benefitting the hospitals and doctors financially more than they do the patients medically. Informality in South Texas Health Care As a result of these three factors (low rates of health insurance coverage , low income, and high costs of medical care), some South Texas residents often turn to informal options to meet their health care needs. Dora mentioned going to Mexico and using home remedies for some illnesses...

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